应用额部皮瓣三期法修复外伤后鼻缺损

Application of three-stage repair with forehead flap in the reconstruction of traumatic nasal defects

目的探讨应用额部皮瓣三期法修复外伤后鼻缺损的方法及效果。方法自2004年6月至2010年10月，对6例外伤后鼻缺损患者分三期进行修复。I期急诊清创，设计切取额部旁正中皮瓣，远端带毛发部分折叠后修复鼻衬里，近端修复外面的皮肤缺损，蒂部裸露创面及额部供区取中厚皮片移植修复；Ⅱ期将皮瓣近端掀起，切除皮瓣下额肌及部分皮下脂肪行皮瓣削薄，再取耳甲软骨移植修复软骨缺失，最后将皮瓣缝回至原位；Ⅲ期行皮瓣断蒂，蒂部回纳至额部及皮瓣近端削薄修整。结果6例患者的皮瓣完全成活。术后随访4个月至2年，鼻部瘢痕不明显，其中鼻外形功能良好者4例，皮瓣与鼻残余皮肤色差较明显者1例，再造鼻翼缘有稀疏毛发生长者1例。结论额部皮瓣三期法简单易行，用于修复外伤后鼻缺损可取得外形及功能均较满意的效果。

Objective To investigate the effects of three-stage repair by forehead flap on the reconstruction of nasal defects after trauma. Methods From June 2004 and October 2010, 6 patients with nasal defects after trauma underwent three-stage repair. At the first stage, the paramedian flap was harvested, the distal part of the flap with hair was folded and transferred to repair the nasal lining, and the proximal part of the flap to re- pair the outer skin defect, the exposed wound of the pedicle was covered with thick split-thickness skin grafts. At the second stage, the proximal part of the flap was elevated, the frontalis muscle and the deeper part of the subcutaneous fat under flap were removed and the flap was peeled thin; the conchal cartilage was harvested to repair cartilage defect and the flap was sutured in the original position. At the last stage of the operation, the skin flap pedicle division was performed and the pedicle of the flap was returned to the forehead. Results All 6 flaps survived completely. Follow-up ranged from 4 months to 2 years. All patients were satisfied with incon- spicuous scar, natural contour and good functions except for 1 patient with the color disparity between the flap and the remaining skin of the nose and 1 patient with sparse hairs on the reconstructed alar rim. Conclusion The technique mentioned above is easy to perform and both satisfactory contour and good function can be achieved in the traumatic patients.